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The best instyle article on inflammaging in skincare by Dr Ebru Karpuzoglu, Dr Jessica Weiser and Dr Carl Thornfeldt written by Elise tabin

Dr. Ebru recently illuminated the concept of inflammaging and its impact on the skin, discussing its potential for treatment. We’re thrilled to be featured on Instyle, and here is the scoop: While inflammation can be harmful to our bodies and skin, it serves as a defense mechanism. However, when the signs of inflammaging (a combination of inflammation and aging) start to appear, the damage is often already done. Reversing this damage requires effort, and understanding this continuous cycle is crucial.

Thank you InStyle and Elise for this amazing article

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The Dirty Truth About Inflammaging and How It Can Destroy Your Skin

By Elise Tabin

IN THIS ARTICLE

There’s a lot of misinformation that TikTokers put out there. Not that we’ll wholeheartedly listen to recommendations about using toothpaste as an anti-acne treatment or face tapping instead of Botox (sounds good in theory but not in actuality), but our ears do perk up when we hear the word inflammaging tossed around on the app. That’s because this aging theory is as serious as it sounds and is gaining traction for a good reason.

Even though inflammation is detrimental to our bodies and skin, it’s also the body’s way of defending itself. But once the symptoms of inflammaging (inflammation plus aging) start rearing their ugly little heads, the effects have often made their mark. Undoing the damage takes work – it’s not difficult – and there’s plenty to know about this seemingly never-ending cycle.

In reality, no matter the cause of inflammation, the effect is the same: a breakdown of standard skin function and a sped-up version of aging that includes wrinkled, dry, red and irritated skin that’s more prone to sagging. As the body gets older, it becomes bombarded with more stressors, and its ability to respond correctly and recover quickly starts to slow. So rather than succumbing to the effects of chronic low-grade inflammation, we’re spilling the truth on the importance of reducing inflammaging within the body and skin for more age-resistant skin.

What is inflammaging?

As board-certified dermatologist Jessica Weiser, MD, explains, chronic underlying, low-grade inflammation can cause accelerated tissue damage, collagen loss, and potential inflammatory skin conditions like eczema or even acne-like breakouts. Simply put: the more inflammation in the skin, the more likely it is for healthy skin to break down.

But the skin is a smart, protective shield that serves as a barrier between the outside world and everything else, acting as a line of defense, says Immunologist Dr. Ebru Karpuzoglu, Molecular Medicine and Immunology, and Chief Scientific Officer and Founder of AveSeena. “Skin comprises barriers, the microbiome and its immune system, which is the ‘control center’ for balanced, healthy skin. Without a healthy immune system, the skin microbiome and barrier function fail.”

The skin incurs two types of inflammation, acute inflammation and chronic inflammation, in response to any given stressor to protect the body. Acute inflammation is a healthy and immediate effect on the skin from a foreign substance or bacteria that prompts a rapid onset of symptoms that eventually diminishes. An example is how the skin responds and heals when it is mildly cut or scratched. “However, if the inflammation does not stop, those inflammatory factors become chronic and create a destructive environment in our cells and all body organs,” says Dr. Carl Thornfeldt, Clinical Dermatologist and Creator of Epionce, a medical skincare line. In contrast, chronic inflammation is more long-term, with no end. “Chronic inflammation, which isn’t as visible as acute inflammation, may continue to attack healthy areas if it doesn’t “turn off.” In the skin specifically, chronic inflammation leads to the visible signs of aging such as wrinkles, skin diseases, and even skin cancer.”

Yet, when the skin is compromised, it reacts by unleashing stress factors, like hormones and inflammatory cytokines, to mitigate the problem. “Inflammation is a good thing when it is our warning call and a temporary response to pollution or stress, activating the immune response to help regenerate the skin,” Dr. Karpuzoglu says.

What causes inflammaging?

No matter how hard you try to protect your skin from the age-related effects of inflammation, it’s virtually impossible to be immune to them. That’s because the body is constantly exposed to some form of stress, and urban living conditions make it hard to avoid. Visible inflammation, the type of inflammation most of us are familiar with, is quick to show on the skin’s surface and is usually accompanied by redness, irritation, a rash of some sort, or even minor swelling. But inflammaging, which persists deep within the skin, is like a silent killer of happy, healthy skin.

While no one cause is tied explicitly to inflammaging, many factors are to blame. Board-certified dermatologist Brendan Camp, MD, says inflammaging is often the result of lifestyle choices, such as high sugar diets or external or environmental factors that heighten the body’s stress response. UV exposure and pollution can kick inflammation into high gear, and so can a lack of routine sleep and psychological stress, which triggers a cascade of internal inflammation.

A damaged skin barrier is like an open door for environmental aggravators to penetrate the skin and cause damage to younger skin cells that are still in the maturing process. Dr. Weiser adds that there’s also a theory that senescent cells (cells that don’t die but are no longer actively dividing like healthy cells) trigger a release of pro-inflammatory cytokines.

What does inflammaging look like?

The effects of inflammaging on the skin vary from minimal to extreme. “Still, they almost always include a breakdown of structural proteins, like collagen and elastin, increased redness, changes in the skin barrier, and dehydration,” Dr. Camp says.

Inflammaging can be difficult to diagnose on the skin. “That’s because it causes changes in the skin that are typically attributed to normal aging,” Dr. Camp says. “The process occurs to a certain degree in everyone and may manifest at different ages. All skin types are prone to the effects of inflammation but may manifest changes differently. For example, fair-skinned individuals may be more susceptible to the effects of ultraviolet radiation and its role in inflammaging.”

In the skin, inflammaging can have serious effects, including:

              • Collagen and elastin breakdown: Healthy collagen and elastin are the cornerstones of healthy skin. But when they are eaten away by inflammation, the skin lacks internal support and doesn’t look plump and cushiony. Wrinkles and fine lines are often the byproducts of collagen-deficient skin.
             
              • Dehydrated skin: When inflammation levels are at an all-time high, the skin can’t retain water, and its natural levels of hyaluronic acid start to deplete. With less hydration within the skin, it quickly becomes dehydrated. “Reduced levels of hyaluronic acid in the dermis is what makes skin look and feel plump,” Dr. Camp says. Inflammation can also cause the body to make more than average amounts of hyaluronidase, an enzyme that breaks down hyaluronic acid (the same one used to dissolve unwanted fillers).
             
              • Age spots and hyperpigmentation: Inflammaging is guilty of causing an overproduction of melanin, leading to age spots, dullness, and uneven skin tone. Dr. Camp says that increased pigmentation develops due to skin cells responding to ultraviolet radiation exposure and the damaging effects of free oxygen radicals. Blood vessels in the skin can also become fragile and leaky, leading to a loss of blood flow and oxygen to the skin cells, which can cause the skin to become dull and pale. Dark under-eye circles can also persist.
             
              • The potential for cancerous cells to form:  Dr. Karpuzoglu says inflammaging can contribute to the development of skin cancer by upregulating the presence of free radicals, which leads to DNA damage in the cells. “When these damaged cells are not repaired or eliminated, DNA damage leads to mutagenic properties resulting in cells becoming cancerous.”
             
            • Rosacea, eczema, and psoriasis: While these skin conditions are directly related to chronic inflammation and are characterized by redness, flushing, and broken blood vessels, an overactive inflammatory response can worsen them. “Inflammaging can also contribute to background redness and blotchiness,” adds Dr. Camp.

How to prevent inflammaging:

The good news is that inflammaging can be prevented — and even reversed — but it takes dedication. For starters, the more you can control your skin from becoming inflamed, the less premature aging and damage it will incur. That means avoiding direct sun exposure whenever possible and wearing sunscreen daily since UV radiation is a known cause of skin inflammation. Formulations that go beyond basic protection, like Purito Daily Soft Touch Sunscreen, which contains five different ceramides to protect the skin barrier, add even more defense.

Using the right skincare products is critical. Dr. Karpuzoglu says products with calming ingredients, ceramides and formulations specifically formulated to address the causes of inflammation and inflammaging are best. Ones to try are the antioxidant-rich AveSeena Micro Algae Immun-B3 Serum and skin-strengthening Nuebiome Biome Balancing Creamy Cleanser, which can help reverse the damage and help strengthen the skin barriers.

Antioxidants, like vitamin C, meadowfoam, and safflower are important not to gloss over. Dr. Thornfeldt says they shield the skin from oxidative stress, allow it to heal quicker and block out free radicals that kick-start the inflammation process into high gear. Epionce Renewal Facial Cream is created with natural ingredients to help boost the skin barrier, calm redness, and increase moisture levels.

You are what you eat, and if your diet is high in inflammatory foods, like processed foods and starches and sugar, you can bet that your internal inflammation levels are relatively high too. So swap sugary and refined foods for clean, lean antioxidant-rich proteins, vegetables and fruits, and load up on teas, too. “Eating a diet rich in fruits, vegetables, and omega-3 fatty acids can help to reduce inflammation throughout the body, including in the skin,” Dr. Karpuzoglu says. Limiting alcohol intake can also be beneficial. Exercise and stress management techniques, like yoga and meditation, are also critical to prevent inflammaging.

How to treat inflammaging:

It’s important not to let inflammaging spiral out of control. Dr. Karpuzoglu says that if inflammaging is left untreated, the immune system will continue fighting against it. Still, it will not have the time or energy to remove dead cells or repair the collagen and elastin for a youthful-looking complexion.

Dr. Karpuzoglu recommends following a simple skincare routine and avoiding harsh physical exfoliants and acids that can strip the skin’s barriers and microbiome and stress it even more. “A skincare routine that helps to calm and comfort while bolstering the skin’s defenses against external aggressors is important. Barrier support through niacinamide, vitamins C and E, hyaluronic acid, or micronutrients, and skin-mimicking materials like ceramides help to support your skin’s natural abilities to revitalize and repair itself.”

Dr. Weiser adds that topical and systemic anti-inflammatory treatments can be helpful, like treating other forms of inflammation. She says the most effective treatments include a combination of topical and oral antioxidants and actives such as azelaic acid to reduce redness and inflammation. In addition, retinol and retinoids can help build back depleted collagen in the skin and regulate skin cell turnover. You’ll want to use them cautiously since they can be inflammatory if what you’re using is too strong. “Procedurally, boosting collagen production through in-office treatments, and decreasing redness and vascularity using lasers could also be beneficial.”

As a standard measure, it’s important not to be too aggressive on the skin or use anything, be it a product or treatment, that’s harsh and can potentially irritate the skin and inflame it. While inflammaging is a more advanced and systemic type of inflammation, it’s still a kind of inflammation, and anything pro-inflammatory can be detrimental to the skin’s health.

FAQ & Summary

What is inflammaging?

Inflammaging refers to chronic, low-grade inflammation that accelerates tissue damage, collagen loss, and may lead to skin conditions like eczema and acne. This kind of inflammation makes the skin's protective capabilities falter, impacting the immune system and barrier functions of the skin, ultimately leading to premature aging.

How does the skin respond to inflammaging?

The skin reacts to inflammaging by losing its ability to maintain healthy collagen and elastin, becoming dehydrated, and suffering from a breakdown in skin barrier function. Over time, this can lead to visible signs of aging such as wrinkles, age spots, and even skin cancer, as persistent inflammation damages skin cells and their DNA.

What causes inflammaging?

Inflammaging can be triggered by various factors including poor diet, particularly high in sugars, environmental stressors like UV radiation and pollution, lack of sleep, and psychological stress. These elements collectively contribute to sustained inflammation that harms skin health and accelerates aging.

What are the visible signs of inflammaging on the skin?

Visible effects of inflammaging include increased redness, breakdown of collagen and elastin, dehydration, and changes in skin tone and texture. These changes are often mistaken for normal aging but are actually due to chronic inflammation.

What are the best skincare practices for treating inflammaging?

To effectively manage signs of inflammaging, it's essential to adopt skincare practices that support and repair the skin's barrier function. This includes using gentle cleansers and moisturizers enriched with ceramides, hyaluronic acid, and antioxidants like vitamins C and E. Treatments such as retinoids should be used carefully to avoid exacerbating skin inflammation.

Scientific Publications on Inflammaging

  1. Franceschi C, Bonafè M, Valensin S, Olivieri F, De Luca M, Ottaviani E, De Benedictis G. Inflamm-aging. An evolutionary perspective on immunosenescence. Ann N Y Acad Sci. 2000 Jun;908:244-54. doi: 10.1111/j.1749-6632.2000.tb06651.x. PMID: 10911963.
  2. Fulop T, Larbi A, Pawelec G, Khalil A, Cohen AA, Hirokawa K, Witkowski JM, Franceschi C. Immunology of Aging: the Birth of Inflammaging. Clin Rev Allergy Immunol. 2023 Apr;64(2):109-122. doi: 10.1007/s12016-021-08899-6. Epub 2021 Sep 18. PMID: 34536213; PMCID: PMC8449217.
  3. Di Giosia P, Stamerra CA, Giorgini P, Jamialahamdi T, Butler AE, Sahebkar A. The role of nutrition in inflammaging. Ageing Res Rev. 2022 May;77:101596. doi: 10.1016/j.arr.2022.101596. Epub 2022 Feb 24. PMID: 35219904.
  4. Agrawal R, Hu A, Bollag WB. The Skin and Inflamm-Aging. Biology (Basel). 2023 Nov 2;12(11):1396. doi: 10.3390/biology12111396. PMID: 37997995; PMCID: PMC10669244.

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